This information about coronavirus and breastfeeding is checked regularly and will develop in response to guidelines and evidence.  This page was last updated on 23rd December 2021.

BfN's Statement on COVID-19 Vaccines while breastfeeding

This statement aims to address the questions we are receiving.  It is for information only and not intended to promote the vaccine or replace advice from a healthcare professional.

If you are breastfeeding or giving your expressed milk, you can have any of the three vaccines currently available in the UK (Astra Zeneca, Pfizer/BioNTech or Moderna), as long as you meet the other conditions for receiving the vaccine, as set out by the Medicines and Healthcare products Regulatory Agency (MHRA) and Joint Committee on Vaccination and Immunisation (JCVI). As with other vaccines, there is no evidence that anything other than antibodies passes into your breast milk. These antibodies are not harmful to your baby, and may give some protection against the virus.  There is no need to avoid giving your baby your breast milk directly after you have the vaccine, either by missing breastfeeds, or expressing and dumping milk.

The JCVI has recommended that the vaccines can be received whilst breastfeeding. This is in line with recommendations from the USA and the World Health Organization.

FAQs

When should I have the vaccine? Vaccination is recommended during pregnancy and breastfeeding so you can have the jab, including boosters, as soon as you are invited.

I am pregnant, can I have the vaccine? Yes. The COVID-19 Vaccine is recommended for pregnant women. Pregnant women are at increased risk of serious illness as a result of COVID-19 and the JCVI has placed them in priority group 6, alongside adults under 65 with long term health conditions.  The JCVI and RCOG recommend that you have the Moderna or Pfizer/BioNTech vaccines as these have been studied more extensively in the USA. However, if you have already had one dose of the AstraZeneca vaccine you will be encouraged to have the second dose of the same vaccine as there is no evidence of risk nor of benefit in mixing the vaccines. For more information, see Pregnant women urged to come forward for COVID-19 vaccination – GOV.UK (www.gov.uk)

I am under 40 and understand that I will be offered the Moderna or Pfizer/BioNTech vaccine. Can I still breastfeed? Yes. You should not stop breastfeeding in order to be vaccinated against COVID-19. There is currently less experience with the Moderna vaccine but MHRA and JCVI have recommended that you continue to breastfeed as normal.  There is no reason to believe that it behaves any differently to the other versions. There is significant data on the Pfizer/BioNTech vaccine in breastfeeding.

I am planning to breastfeed after my baby is born, can I still have the vaccine now? Yes. Pregnant women are at increased risk of serious illness as a result of COVID-19 and the JCVI has placed them in priority group 6, alongside adults under 65 with long term health conditions. Pregnant women can have any of the three licensed vaccines straight away or at any point during their pregnancy and breastfeed as normal when their baby is born. In pregnancy you will normally be offered the Moderna or Pfizer/BioNTech vaccines. They are both compatible with breastfeeding.

I am breastfeeding, can I have the vaccine? Yes, you can have any of the three licensed vaccines, as initial doses or as a booster, and continue to breastfeed as normal.

I stopped breastfeeding after I had the vaccine. Can I restart now? If you want to re- stimulate your milk supply or talk through your experience, then you can contact the National Breastfeeding Helpline.  Our aim is to support individual, informed decisions based on the best data we have.

Do the vaccines have any side effects that affect breastfeeding, or breastfed children? This text is taken from Coronavirus vaccine – weekly summary of Yellow Card reporting – GOV.UK (www.gov.uk) last updated 9th December 2021:

There is no current evidence that COVID-19 vaccination while breastfeeding causes any harm to breastfed children or affects the ability to breastfeed.

We have received about 3,500 Yellow card reports from women breastfeeding at the time of vaccination. Most of these women reported only suspected reactions in themselves which were similar to reports for the general population, with no effects reported on their milk supply or in their breastfed children.

A small number of women have reported decreases in their milk supply, most of which were transient, or possible reactions in their breastfed child. A number of factors can affect milk supply and infant behaviour, including general maternal health, amount of sleep, and anxiety. The symptoms reported for the children (high temperature, rash, diarrhoea, vomiting and general irritability) are common conditions in children of this age, so some of the effects reported may have occurred by coincidence.

A small number of women may experience a reduction in their breast milk production and it may be helpful for breastfeeding women to know how to maintain their breast milk supply, particularly if they are feeling unwell.

I have heard that the vaccines make you feel unwell, will I be able to care for my baby? Some people report headaches, flu-like symptoms, general aches and pains, nausea, and gastrointestinal symptoms. Taking paracetamol and drinking plenty of fluids to keep you hydrated may help alleviate symptoms.  Paracetamol can be taken as normal when pregnant or breastfeeding. As some people report feeling tired in the day or two after the vaccine, you might want to have your vaccine when someone is around to help you care for your baby and bring them to you for feeding. If you usually express milk, you could express some extra ahead of time in case you want to use it. Remember that missing feeds may lower your supply and could lead to blocked ducts or mastitis.

If you believe you have experienced an adverse reaction to a vaccine, you can report this via the yellow card system: https://coronavirus-yellowcard.mhra.gov.uk/

Summary: which vaccine can I have and when?

AstraZeneca Pfizer/BioNTech Moderna
Pregnancy second dose yes if had 1st dose of AstraZeneca yes yes
Breastfeeding yes yes yes
Under 40s second dose yes if had 1st dose of AstraZeneca yes yes
MHRA's position on breastfeeding and COVID-19 vaccination – 2nd September 2021

There is no current evidence that COVID-19 vaccination while breastfeeding causes any harm to breastfed children or affects the ability to breastfeed.

  • COVID-19 vaccines do not contain live components and there is no known risk associated with being given a non-live vaccine whilst breastfeeding. The current advice of the Joint Committee on Vaccination and Immunisation (JCVI) is that breastfeeding parents may be offered any suitable COVID-19 vaccine depending on their age.
  • The MHRA closely monitors the safety of COVID-19 vaccines during breastfeeding, including evaluation of Yellow Card reports for COVID-19 vaccines from breastfeeding women. These reports have been reviewed by the independent experts of the Commission on Human Medicines' COVID-19 Vaccines Benefit Risk Expert Working Group, by paediatric and breastfeeding experts.
  • We have received about 3,000 Yellow card reports from women breastfeeding at the time of vaccination. Most of these women reported only suspected reactions in themselves which were similar to reports for the general population, with no effects reported on their milk supply or in their breastfed children.
  • A small number of women have reported decreases in their milk supply, most of which were transient, or possible reactions in their breastfed child. A number of factors can affect milk supply and infant behaviour, including general maternal health, amount of sleep, and anxiety. The symptoms reported for the children (high temperature, rash, diarrhoea, vomiting and general irritability) are common conditions in children of this age, so some of the effects reported may have occurred by coincidence.
  • A small number of women may experience a reduction in their breast milk production, and it may be helpful for breastfeeding women to know how to maintain their breast milk supply, particularly if they are feeling unwell. The NHS website has a good resource for this: www.nhs.uk/start4life/baby/breastfeeding
  • MHRA will continue to monitor the safety of COVID-19 vaccines. As with any safety issue, they will keep this under review.
  • The MHRA publishes its review of suspected adverse drug reactions to the COVID-19 vaccines every week. More can be found here: https://www.gov.uk/…/coronavirus-covid-19-vaccine…
Latest research

Children who have ever been breastfed found less likely to test positive for COVID-19

An observational study looking at children aged 14 and under who attended the emergency room on specific days over a three month period found that those who had ever been breastfed (even years before the start of the pandemic) were significantly less likely to test positive for COVID-19 than those who had never been breastfed. Whilst there are other factors that could contribute to this effect (variables such as household income were not factored in), this result suggests that breastfeeding could give some long–term resilience to infections that the child may encounter in the future, including COVID-19.

Verd, S., Ramakers, J., Vinuela, I.et al. Does breastfeeding protect children from COVID-19? An observational study from pediatric services in Majorca, Spain.Int Breastfeed J16,83 (2021). https://doi.org/10.1186/s13006-021-00430-z

Higher levels of SARS-CoV-2 antibodies found in breast milk of mothers who have breastfed for two years or more.

Research by Ramirez et al, published in August 2021, has confirmed the results of previous studies, showing that breastmilk from mothers who have had two doses of the COVID-19 vaccination have SARS-CoV-2 antibodies in their breastmilk two weeks after receiving the second vaccination. These antibodies were not found in mothers who have not been vaccinated. They also found that there were higher levels of antibodies in the milk from mothers who had been breastfeeding for two years or more. This shows that breastmilk could still have important protective benefits for older breastfeeding children, as well as babies.

Reference:
Ramírez DSR, Pérez MML, Pérez MC, et al. SARS-CoV-2 antibodies in breast milk after vaccination. Pediatrics. 2021; doi: 10.1542/peds.2021-052286.  https://pediatrics.aappublications.org/content/pediatrics/early/2021/08/17/peds.2021-052286.full.pdf

SARS-CoV-2 antibodies found in breastmilk after maternal vaccination

A recent study has shown that breastmilk from mothers vaccinated against COVID-19 contains antibodies which could help protect their infants against the virus.

The study included 32 breastfeeding women who had already decided to be vaccinated. They received the Pfizer–BioNTech vaccine, given in two doses, 21 days apart. The control group included 28 breastfeeding women who were not vaccinated against COVID-19.

COVID-19 antibodies were found in the breastmilk of all vaccinated mothers, but not in the breastmilk of mothers in the non-vaccinated group. The antibodies reached the highest observed level at around 29 days after the first dose (7 days after the second dose), and were still present at around 43 days after the first dose (22 days after the second dose).

Research looking at mothers who have been diagnosed with COVID-19 has shown that their breastmilk also contains antibodies to the virus, and that in a lab, this breastmilk is able to neutralise the virus. This means that breastmilk containing antibodies could give breastfed infants some protection against the virus. A study looking at the breastmilk of vaccinated women showed that the levels of antibodies in their breastmilk were higher than in women who had been diagnosed with COVID-19, showing that vaccination could give breastmilk stronger protective properties than catching the virus.

None of the infants of the vaccinated mothers in the study experienced any serious side effects after their mothers received the vaccination, and most experienced no side effects at all. Overall, this research supports the importance of breastfeeding women receiving the COVID-19 vaccine.

Reference:
Jakuszko, K. et al. Immune Response to Vaccination against COVID-19 in Breastfeeding Health Workers. Vaccines, 2021, 9, 663. https://www.mdpi.com/2076-393X/9/6/663/htm

Maternal and Child Symptoms Following COVID-19 Vaccination Among Breastfeeding Mothers

This report looked at 4,455 breastfeeding mothers who received either the Pfizer or Moderna COVID-19 vaccination. Of these, 77 mothers (1.7%) reported negative effects on breastfeeding. It was noted that these mothers also reported more severe reactions to the vaccine themselves. Overall, 7.1% of mothers reported any symptoms in their breastfed children following COVID-19 vaccination. These are shown in the table below. Other perceived symptoms in the children reported by three or more mothers included runny nose and flushing of cheeks.

https://www.liebertpub.com/doi/10.1089/bfm.2021.0079

The team concluded that COVID-19 vaccination among breastfeeding mothers resulted in minimal impact on breastfeeding and minimal side effects in the breastfed child.

Reference:
Skyler McLaurin-Jiang, Christine D. Garner, Kaytlin Krutsch, and Thomas W. Hale. Breastfeeding Medicine. ahead of print http://doi.org/10.1089/bfm.2021.0079 https://www.infantrisk.com/content/results-breastfeeding-and-covid-19-vaccine-survey

Early published results which are promising but very limited in numbers of cases studied:
  1. Baird JK et al SARS-CoV-2 antibodies detected in human breast milk postvaccination (published 2 March 2021) that they had identified the presence of SARS-CoV-2 specific immunoglobulins (covid-19 antibodies) in the milk of 6 vaccinated mothers.

https://www.medrxiv.org/content/10.1101/2021.02.23.21252328v1.full.pdf?fbclid=IwAR3l5hlpS0L6J–vwuq7odYHJ3aB6P8OjEdu-Fy_vvzCjLh-yLnv0MqMp5s].

The conclusion of the group is:

"Currently, there is little to no research to guide lactating women and their healthcare providers when deciding whether or not to get vaccinated. We provide the first evidence that mothers vaccinated against SARS-CoV-2 produce antibodies to this virus in breast milk that may be protective for infants.

2.            Peng S et al 2020. A study of breastfeeding practices, SARS-CoV-2 and its antibodies in the breast milk of mothers confirmed with COVID-19

https://www.thelancet.com/journals/lanwpc/article/PIIS2666-6065(20)30045-6/fulltext#seccesectitle0001]

Studied 24 mothers with confirmed COVID-19 and 19 with suspected infection compared to a control group of 21 without infection. All 44 breast milk samples tested negative for the SARS-CoV-2 nucleic acid. There was no evidence of the SARS-CoV-2 virus in breast milk. The presence of IgM in some samples suggests the possibility that breast milk might have a protective effect on newborns. Breastfeeding duration was impacted by separation of mothers and babies during infection.

3.            Gilbert P, Rudnick C.  Newborn Antibodies to SARS-CoV-2 detected in cord blood after maternal vaccination

https://www.medrxiv.org/content/10.1101/2021.02.03.21250579v1?fbclid=IwAR2Uwu7PKrm1bulzYxYUC8V-AP_ur2_bDAaW99RSUe4wj78YbhUYztpRpYM]

The first report of an infant with SARS-CoV-2 IgG antibodies detectable in cord blood after maternal vaccination. SARS-CoV-2 has already been identified in the milk of mothers exposed to COVID-19 infection They have also been detected in one mother vaccinated in pregnancy but naïve to COVID-19 infection, in cord blood of her newborn

4.            Mahase E Covid-19: Pregnant women should be offered Pfizer or Moderna vaccine.

https://www.bmj.com/content/373/bmj.n1013?utm_source=etoc&utm_medium=email&utm_campaign=tbmj&utm_content=weekly&utm_term=20210423

"Those planning pregnancy, in the immediate postpartum, or breastfeeding can be vaccinated with any vaccine, depending on their age and clinical risk group"

5.            Perl SH, Uzan-Yulzari A, Klaine H et al. SARS-CoV-2–Specific Antibodies in Breast Milk After COVID-19 Vaccination of Breastfeeding Women

https://jamanetwork.com/journals/jama/fullarticle/2778766

Studied 84 women in Israel after 2 doses of Pfizer BioNTech vaccine 21 days apart. Anti–SARS-CoV-2-specific IgG antibodies remained low for the first 3 weeks, with an increase at week 4 (20.5 U/mL; P = .004), when 91.7% of samples tested positive, increasing to 97% at weeks 5 and 6.

No mother or infant experienced any serious adverse event during the study period. Forty-seven women (55.9%) reported a vaccine-related adverse event after the first vaccine dose and 52 (61.9%) after the second vaccine dose, with local pain being the most common complaint. Four infants developed fever during the study period 7, 12, 15, and 20 days after maternal vaccination. All had symptoms of upper respiratory tract infection including cough and congestion, which resolved without treatment except for 1 infant who was admitted for neonatal fever evaluation due to his age and was treated with antibiotics pending culture results. No other adverse events were reported.

Sources of information on compatibility with the vaccine and breastfeeding:
Can I breastfeed if I have COVID-19?

Current evidence suggests that it is safe to breastfeed and continue to offer breastmilk if you have COVID-19. "The long-term well established benefits of breastfeeding are highly likely to outweigh any potential risks of transmission of the virus through breastmilk" (RCOG, RCM July 2020, Walker, June 2020 & WHO June 2020)

In fact, breastmilk is the best source of nutrition for infants and provides protection against many illnesses. If you have confirmed COVID-19 or have symptoms you should take all possible precautions to avoid spreading the virus to your baby, including washing your hands before touching your baby, sterilising any breast pump or bottles and washing your hands after changing their nappy.

Consider wearing a face covering or fluid-resistant face mask while feeding or caring for the baby.

If your baby is older it may be safer to leave your mask off to avoid them pulling at it and touching your secretions.

Babies should not wear a face covering or mask as they may risk suffocation.

If you are too unwell to breastfeed you may still be able toexpress milk for your baby. Pump equipment and bottles need to be sterilised according to manufacturer's instructions.

It can be difficult to differentiate between a cold, flu and coronavirus. The information in this diagram may help: https://www.bbc.co.uk/news/health-54145299

Information on medicines and over the counter remedies:

For information on cough and cold remedies when you are breastfeeding see: https://www.breastfeedingnetwork.org.uk/cold-remedies/

For information on products which help to relieve sore throats: https://www.breastfeedingnetwork.org.uk/sore-throats/

For information on painkillers which may also help to relieve temperature and aches & pains: https://www.breastfeedingnetwork.org.uk/analgesics/

Should you be diagnosed with COVID-19 and be admitted to hospital you may be prescribed stronger medication including anti-virals:
See https://www.liebertpub.com/doi/full/10.1089/bfm.2020.0268?fbclid=IwAR2OAUf0u5yEbACcrAydssi7JTS68ZVbHrkOnmQgmYVOrLapM1vvbjYLSmo_source=ETOC&utm_medium=email&utm_campaign=bfm

For more information on breastfeeding with COVID19 see FAQ section I am feeling unwell and may have coronavirus found further down this page

References

  • Dumitriu D, Emeruwa UN, Hanft E, et al. Outcomes of Neonates Born to Mothers With Severe Acute Respiratory Syndrome Coronavirus 2 Infection at a Large Medical Center in New York City.JAMA Pediatr. Published online October 12, 2020. doi:10.1001/jamapediatrics.2020.4298
  • Sections 6:1-3, Version 11: updated 24 July 2020. Guidance for healthcare professionals on coronavirus (COVID-19) infection in pregnancy, published by the RCOG, Royal College of Midwives, Royal College of Paediatrics and Child Health, Public Health England and Public Health Scotland.https://www.rcog.org.uk/coronavirus-pregnancy
  • https://www.england.nhs.uk/coronavirus/wp-content/uploads/sites/52/2020/05/C0441-maternity-leaflets-cv19-parent-information.pdf
  • Walker, KF, O'Donoghue, K, Grace, N, Dorling, J, Comeau, JL, Li, W, Thornton, JG. Maternal transmission of SARS-COV-2 to the neonate, and possible routes for such transmission: a systematic review and critical analysis.BJOG 2020; https://doi.org/10.1111/1471-0528.16362. 127: 1324– 1336.
  • https://obgyn.onlinelibrary.wiley.com/doi/10.1111/1471-0528.16362
  • WHO, June 2020, WHO/2019-nCoV/Sci_Brief/Breastfeeding/2020.1
  • https://www.who.int/news-room/commentaries/detail/breastfeeding-and-covid-19
What are the symptoms?

Based on current evidence, the coronavirus presents with flu-like symptoms including a fever, a cough, or difficulty breathing.  Anyone who thinks they have symptoms should visit https://111.nhs.uk/covid-19 or in England, Wales and Northern Ireland should call NHS 111. In Scotland call your GP surgery or call 111 if your surgery is not open. You should stay at home and avoid close contact with other people. Do not go to a GP surgery, pharmacy or hospital.

How to avoid catching or spreading coronavirus

Do:

wash your hands with soap and water often – do this for at least 20 seconds
always wash your hands when you get home or into work

use hand sanitiser gel if soap and water are not available
cover your mouth and nose with a tissue or your sleeve (not your hands) when you cough or sneeze
put used tissues in the bin straight away and wash your hands afterwards
try to avoid close contact with people who are unwell

Don't

touch your eyes, nose or mouth if your hands are not clean

I am feeling unwell and may have coronavirus

If you are feeling unwell, and have symptoms of coronavirus, the general information provided by Public Health England [in the link] should be helpful.
https://www.gov.uk/government/publications/covid-19-stay-at-home-guidance/stay-at-home-guidance-for-households-with-possible-coronavirus-covid-19-infection
Site accessed 10 November 2020

If you suspect you have COVID-19 or it has been confirmed and you want information on breastfeeding follow the link:
https://www.rcog.org.uk/en/guidelines-research-services/guidelines/coronavirus-pregnancy/covid-19-virus-infection-and-pregnancy/
Site accessed 10 November 2020 and last updated 14 October 2020

For links to the Government and devolved administration sites please see FAQ section Can I breastfeed if I have COVID-19?further up this page.

The main points include:

  • Wash your hands before touching your baby, breast pump or bottles
  • Try to avoid coughing or sneezing on your baby while feeding, whether breastfeeding or giving a bottle.*
  • Consider wearing a face mask while breastfeeding or bottle feeding, If your baby is older it may be safer to leave your mask off to avoid them pulling at it and touching your secretions. Discuss options with your midwife, health visitor or GP..
  • Follow manufacturers recommendations for pump cleaning after each use.
  • If you are feeling too unwell to breastfeed directly consider asking someone who is well to feed your expressed breast milk to your baby.
  • If you choose to feed your baby with formula or expressed milk, it is important that you follow the sterilisation guidelines https://www.nhs.uk/conditions/pregnancy-and-baby/sterilising-bottles/
  • If you are expressing breast milk in hospital, a dedicated breast pump should be used. The hospital may have guidance about bringing the bottles into the neonatal unit

*This is to ensure good respiratory hygiene when close to your baby such as when feeding, or changing their nappy.

If you would like to know more about donor milk as an option while you are ill follow this link to find your nearest milk bank. Supplies are limited, they will do what they can. http://www.ukamb.org/

If your baby needs to be cared for in a Neonatal Unit (NICU) these links have general information and specific details about COVID-19.

Frequently asked questions within neonatal services – these are detailed and written for clinicians. In the section Managing provision of expressed breast milk (EBM) in the NNU when mother is SARS-Co-V positive

It states "Current national advice for well babies of COVID-19 suspected or confirmed mothers is that the benefits of breast feeding outweigh any theoretical risks." And then states:

"For unwell or preterm babies in the NNU the evidence is less clear. Practitioners should discuss with parents the pros and cons of provision of EBM to babies in the NNU, noting the current uncertainty. A joint decision should be informed by factors including the gestation and clinical condition of the baby, transfer of protective maternal antibodies, the availability of donor breast milk and parental choice. Other coronaviruses are destroyed by pasteurisation."

The document may help when discussing being with your baby in the neonatal setting: "Neonatal services present a unique situation in terms of "visitors" and it is essential that the mother and her partner are never considered to be visitors within the neonatal unit – they are partners in their baby's care, and their presence should be encouraged (See Bliss statement at the link below) The mother and her newborn are a biological entity and should have unrestricted contact when admission to a NNU is unavoidable."

https://www.rcpch.ac.uk/resources/covid-19-guidance-neonatal-settings

https://www.bliss.org.uk/health-professionals/information-and-resources/parental-access-covid19
Site accessed 10 November 2020 and last updated 23 October 2020

There are unacceptable variations around the UK to which [a]n NHS England spokesperson said: "The NHS has been clear that parents should be with their babies in neonatal units as much as possible and any restrictions should only happen when absolutely necessary."
https://www.theguardian.com/society/2020/nov/16/mothers-needlessly-separated-babies-hospital-covid-rules

Guidance for Health Professionals here:
https://www.unicef.org.uk/babyfriendly/COVID-19/

Further research collated by Unicef UK BFI is available here:
https://www.unicef.org.uk/babyfriendly/news-and-research/baby-friendly-research/coronavirus-research/

BFI sites last accessed 16 November 2020

Expressing milk and donor milk :

If you are expressing breast milk in hospital, a dedicated breast pump should be used. The hospital may have guidance about bringing the bottles into the neonatal unit.

If you would like to know more about donor milk as an option while you are ill follow this link to find your nearest milk bank. Supplies are limited, they will do what they can. http://www.ukamb.org/ and https://heartsmilkbank.org/milk/

Information on medicines and over the counter remedies:

For information on cough and cold remedies when you are breastfeeding see: https://www.breastfeedingnetwork.org.uk/cold-remedies/

For information on products which help to relieve sore throats: https://www.breastfeedingnetwork.org.uk/sore-throats/

For information on painkillers which may also help to relieve temperature and aches & pains: https://www.breastfeedingnetwork.org.uk/analgesics/

Should you be diagnosed with COVID-19 and be admitted to hospital you may be prescribed stronger medication including anti-virals:
https://www.liebertpub.com/doi/full/10.1089/bfm.2020.0268?fbclid=IwAR2OAUf0u5yEbACcrAydssi7JTS68ZVbHrkOnmQgmYVOrLapM1vvbjYLSmo_source=ETOC&utm_medium=email&utm_campaign=bfm

For further information:

  • Drugs in Breastmilk information here: https://www.breastfeedingnetwork.org.uk/detailed-information/drugs-in-breastmilk/
  • Facebook link here: https://www.facebook.com/BfNDrugsinBreastmilkinformation/

Drugs in Breastmilk information service can be reached via the Facebook page, or email druginformation@breastfeedingnetwork.org.uk

Links checked 10 November 2020

Starting breastfeeding - the first few days.

Women tell us that days 3 or 4 can be a time of change and feelings of being overwhelmed together with tiredness can be common. You may also feel isolated during this time of public worry and restrictions on social contact. Staying connected with your baby as your body adapts to support your baby's needs is important as is knowing where you may be able to get help if you need it. You may notice your breasts becoming warmer and tingly as they begin filling with milk and your baby may be more unsettled and feed in unpredictable patterns. Take each feed, one at a time, spending time with your baby as you both learn from each other. When possible keeping together in skin to skin will help to calm your baby.  Knowing what to look out for can help you see and feel how well your baby is feeding. Learning and recognising some simple signs can make all the difference.

How is feeding going?

Helping your baby attach well will allow them to make the most of your milk and avoid hurting your breasts. You are looking for short sucks to begin, which can feel strong, followed by long rhythmic sucks and swallows. When your baby finishes the feed, they should appear content and satisfied – though they may want more from the second breast before they finally settle. Your nipples should look like they did before the feed, if sore, misshapen or have pressure lines, the attachment may have shifted during the feed – this is something to work on. Keep in mind the phrase 'CHINS', trained peer supporters use this acronym when supporting mothers to help remember the ways of holding and attaching your baby: Close, your baby needs to be close to you so that they can scoop enough breast into their mouth Head free, so your baby can tilt their head back when attaching to your breast. This allows their chin to lead as he comes on to the breast In Line, your baby's head and body need to be in a straight line so they are comfortable and can swallow easily. Nose to nipple, this should be at the top of the list – start the feed with your nipple level with your babies nose so that as they root and tilt their head you can bring them closer to you so they will be well attached. Sustainable, comfortable for both of you through the feed. Your baby's wet and dirty nappies are a good indication of the amount of milk taken.

The first 48 hours

  • At the beginning, your baby will pass a black tar-like poo (called meconium)
  • In the first 48 hours, your baby is likely to have only 2 or 3 wet nappies.

Wet nappies should then start to become more frequent, with at least 6 every 24 hours from day 5 onwards. You may notice an orange or red, brick-dust coloured stain in your baby's nappy in the first couple of days after birth. This can look alarmingly like blood, but is urate crystals, which is normal at this time. As feeds increase the urine will become less concentrated and the staining will disappear. Let your midwife know if it is still there by day 3 or 4. It is also common for baby girls to have a vaginal discharge in the first few days after birth. At times this may be slightly blood stained and is due to the presence of your hormones in your daughter's body; this is entirely normal but if in doubt please check with your midwife. https://www.cuh.nhs.uk/rosie-hospital/pregnancy-labour-and-birth/going-home/caring-for-your-baby/what%E2%80%99s-nappy

Days 3-4

  • By day 3, your baby's poo becomes easier to clean as the meconium mixes with your milk and should be changing to a lighter, loose, greenish poo.
  • From day 4 and for the first 4 – 6 weeks your baby should pass at least 2 yellow poos every day, with poos at least the size of a £2 coin.

If on any day during the first week your baby has not had a poo, or you have any concerns,  call the National Breastfeeding Helpline. You can also speak to your midwife. They will help you check how well your baby is feeding and any difficulties you may be having. There will be many times when your baby is doing well with a gap in poo, yet it is better to be careful and to seek support to help guide you. To discuss this, or any question, ask your midwife or call the National Breastfeeding Helpline, 0300 100 0212, open 9.30am-9.30pm, every day of the year. It's important to stay connected so call as often as you like.

Link to all the breastfeeding support available during COVID-19 https://www.breastfeedingnetwork.org.uk/breastfeeding-support-in-the-uk-during-the-coronavirus-covid-19-situation/

These links below can make it all seem easy when the reality may be harder. Talk it through with someone on the helpline as they are skilled at knowing how to help.

See colour changes of baby poo on p17 https://www.unicef.org.uk/babyfriendly/wp-content/uploads/sites/2/2010/11/otbs_leaflet.pdf

Beginning breastfeeding https://www.nhs.uk/conditions/pregnancy-and-baby/breastfeeding-positioning-attachment/

Longer, ten minute, video showing more detail on attachment and how babies signal they are ready to feed through feeding cues https://globalhealthmedia.org/portfolio-items/attaching-your-baby-at-the-breast/

First feeds https://web.bestbeginnings.org.uk/web/video/your-babys-first-feed-1041/videos

Feeding on day 2 – to show babies need to calm to feed. Too upset on first try https://www.breastfeedinginc.ca/baby-28-hours-old-assisted-latching

How can I increase the amount of breastfeeds? I'm breastfeeding and also giving bottles of formula.

If your baby is now breastfeeding after earlier difficulties, and you want to increase breastfeeding, try reducing one of the formula feeds at a time that suits you both. Early to mid-morning is often good, you will know what works for you. Offer your baby's usual breastfeed, from both sides. What happens next depends on you and your baby. Before  offering their usual bottle of formula you could offer another feed from the first and possibly second breast to stimulate more milk. Then offer the bottle of formula For babies drinking larger bottles, or if you want to go more slowly, try dropping 30ml in that feed. Keep the rest of the formula feeds the same throughout the rest of the day. Keep to this pattern each day, for several days so your body adjusts. Your baby may want the next breastfeed sooner or there may not be much difference. After a few days reduce the feed by another 30ml and keep going at this pace until you can stop this feed completely. Then hold this pattern for a few days and when you are both ready try reducing the volume of formula in another bottle. Going slowly like this means you know your baby is not missing out on very much formula and gives your milk time to increase in amount. You can see your baby is receiving enough milk by checking their nappies – they should be producing at least 6 wet nappies (from 6 days and older) and at least 2 poos every 24 hrs. For older babies this pattern may vary so compare with their usual amount of wet and dirty nappies. You may notice their poos change to become runnier and more yellow again. These suggestions are for babies who have been gaining weight and there are no concerns about their ability to feed. It is important to go at a pace that suits your baby. If your baby is used to having a dummy it might reduce the time they would breastfeed so use it sparingly around the time you are dropping the amount of a feed. As an alternative you could express some milk and give that by bottle before finishing the feed with your usual formula – this is harder to sustain as you have 3 different feeding options to juggle. It can be useful as a short-term option, perhaps if your baby has taken a while to learn to feed effectively. If you have difficulties with breastfeeding or have any concerns call the National Breastfeeding Helpline to talk this through. Links rechecked 14 April 2020 https://www.unicef.org.uk/babyfriendly/wp-content/uploads/sites/2/2020/03/Unicef-UK-Baby-Friendly-Initiative-Maximising-breastmilk-and-re-lactation-guidance-3.pdf https://abm.me.uk/breastfeeding-information/relactation/ https://www.who.int/maternal_child_adolescent/documents/who_chs_cah_98_14/en/

I have stopped breastfeeding, can I restart?

Restarting breastfeeding is possible. It takes time, lots of patience and depends on how your baby reacts, some find it surprisingly easy to adjust and others take a while to become interested. Encouraging your baby The following steps can help, there is no exact, or simple way to do this. Watch your baby, follow their cues. Sometimes they need a few days of being with you, skin to skin, before they decide to take an interest in latching on. Find a time where you can lie on your bed propped up on pillow or cushions, or lying on your side, whatever is comfortable for you both. If sitting up hold your baby between your breasts skin to skin. If on your side, lie with your baby close to your breast. Let your baby get used to being close again and explore your breasts. Just like at the beginning they often start by nuzzling and licking your nipple, and reaching out with their hands. You can encourage this by expressing a little milk, if you have some so they can taste it. This can be fiddly and distracting so concentrate on letting them explore until you think it would help. Where your baby has been fed or is being fed from a bottle sometimes a nipple shield can help your baby transition to feeding at your breast. They come in different sizes so you are likely to need help to find one that fits you well and is comfortable for the baby to feed from. Your baby should be well attached so your baby's tongue can reach your breast, past the stalk– this helps your baby get more milk. If the stalk of the nipple shield is too big it can be uncomfortable to feed easily as it can make them gag. This is easier to talk through with a skilled breastfeeding supporter, in person or on the National Breastfeeding Helpline. Stimulating your breasts Use a pump or hand express to stimulate your breasts for 10-15 minutes each side aiming for least eight times in 24 hours, including once at night. The pump should be comfortable, too high a setting is likely to make you sore without increasing your supply. The number of times you express is more important that keeping the expressing times evenly spaced out. Increasing the amount of breastfeeds See the FAQ on increasing the amount of breastfeeds. It is easier to go slowly dropping one feed at a time as it means you know your baby is only missing out on a little formula at any time. For babies drinking larger bottles, or if you want to go more slowly, try dropping 30ml in that feed and hold that pattern for a few days until they have settled into the new pattern. If your baby is unsettled in between feeds try offering an extra breastfeed, this will help boost your milk supply. Mothers often say they find the change from more predictable feeding times unsettling. It takes a while to settle to this new pattern. Some babies will want to go faster so this phase may feel quite intense. You may notice you are getting thirstier and more hungry as your milk supply increases. This is all expected and a good sign you are making more milk. Another sign that your baby is receiving enough milk is that they are producing at least 6 wet nappies (once they are 6 days and older) and at least 2 poos every 24 hrs. For older babies this pattern may vary so compare with their usual amount of wet and dirty nappies. You may notice their poos change to become runnier and more yellow again. If you have difficulties with breastfeeding call the National Breastfeeding Helpline to talk this through. These suggestions are for babies who have been gaining weight and there are no concerns about their ability to feed. It is important to go at a pace that suits your baby. ABM have a leaflet explaining relactation in more detail: https://abm.me.uk/wp-content/uploads/ABM-relactation-breastfeeding.pdf And a leaflet explaining nipple shields: https://abm.me.uk/breastfeeding-information/using-a-nipple-shield-with-a-breastfed-baby/ National Breastfeeding Helpline 0300 100 0212

Is sharing breastmilk safe during coronavirus?

Informal milk sharing is not recommended particularly while coronavirus – COVID-19 is such a concern. Although the virus has not been detected in breastmilk it can stay on the surface of containers and can also be passed on through close contact without the person being aware they have any of the symptoms. http://www.ukamb.org/breastmilk-sharing/

Is donor breastmilk from a milk bank an option?

Pasteurised donor milk may be obtained from a milk bank. Priority is given to the sickest, most premature babies. Mothers with their own breastfeeding challenges may be able to get donor breastmilk if there are sufficient supplies. http://heartsmilkbank.org/milk/

Health workers expressing milk at work

If you express milk at work and are concerned about the possibility of contamination with COVID-19 the following information, checked on the 20 April 2020, may help. The priority is your own safety, and that of your baby. If you are caring for patients with COVID-19 while expressing for your own baby, the intensity of the environment may make fitting in these sessions harder. Summary COVID-19 is new and will take a while before the evidence becomes more settled. COVID-19 is not known to be transmitted in breastmilk. However, COVID-19 has the potential to contaminate surfaces which could include the outside of bottles and breast pump. The following resources may be useful if you are working in an environment where this is a possibility e.g. patients have tested positive for COVID-19, or are suspected of having the virus. The guide #COVID19 and Breastfeeding for Healthcare Professionals [1] is written by doctors for their own use. The guide covers practical options – handling your pump, and setting up a decontamination area at your front door. Good hand hygiene before and after expressing is vital along with careful cleaning of pump parts. In the UK the general guidance for cleaning pumps is to follow the manufacturers instruction, repeated here in the RCOG / RCM Guidance [p34] below. [2 & 3] Milk storage containers are classed as a food contact surface and as such the use of chemical disinfectants on the outside of filled containers is not recommended (HMBANA, April 2020). [4] The HMBANA infographic guide [4] has suggestions for transferring milk after expressing into clean bottles which may be helpful. Standard milk storage times apply [5] References [1] Breastfeeding and COVID-19 for HCPs [2] Coronavirus (COVID-19) Infection in Pregnancy:  Information for healthcare professionals Version 7: Published Thursday 9 April 2020 https://www.rcog.org.uk/coronavirus-pregnancy [3] UK instructions for sterilising bottles and pump parts https://www.nhs.uk/conditions/pregnancy-and-baby/sterilising-bottles/ [4] Milk Handling for COVID-19 Positive or Suspected Mothers in the Hospital Setting Accessed 16/04/2020 https://www.hmbana.org/news/milk-handling-for-covid-19-positive-or-suspected-mothers-in-the-hospital-setting.html [5] Expressing and storing information https://www.breastfeedingnetwork.org.uk/breastfeeding-help/expressing-storing/

Breastfeeding support in the UK during the COVID-19 situation

Breastfeeding supporters in the UK – both voluntary and paid – are skilled and experienced in offering breastfeeding support over the phone and online.  Several helplines are available, and many have increased capacity:

  • National Breastfeeding Helpline (run by the Association of Breastfeeding Mothers and the Breastfeeding Network) – 0300 100 0212 Open 9.30am-9.30pm, every day of the year.  This line also includes an option for Welsh and Polish language support.
  • Breastfeeding Network Bengali/Sylheti Helpline 0300 456 2421
  • The National Breastfeeding Helpline also provides support via web chat at www.nationalbreastfeedinghelpline.org.uk and via Facebook messenger www.facebook.com/nationalbreastfeedinghelpline
  • The Breastfeeding Network's Drugs in Breastmilk Information service offers evidence based info on the safety of medications and treatments during breastfeeding.  A series of fact sheets covering a wide range of issues and medications can be found at: www.breastfeedingnetwork.org.uk/drugs-factsheets Or you can message the BfN Drugs in Breastmilk Information page on Facebook at www.facebook.com/BfNDrugsinBreastmilkinformation Or email druginformation@breastfeedingnetwork.org.uk
  • La Leche League– 0345 120 2918 (8am-11pm) and visit https://www.laleche.org.uk/get-support/ for a range of online and telephone breastfeeding support options.
  • NCT – 0300 330 0700 Feeding line (8am-midnight) https://www.nct.org.uk/baby-toddler/feeding/early-days/breastfeeding-support-nct
  • You can also contact your local health visiting team or local infant feeding support team to see what other resources are available. An internet search using 'breastfeeding' and the name of your town or county will usually get you to the right teams. In many areas, there are increased levels of phone support and support available online and through video.
  • You can also visit lcgb.org to find a local lactation consultant: https://www.lcgb.org/find-an-ibclc/. Many are offering additional remote support options.
  • There are several reliable sources of online information about breastfeeding, talking about what's normal and how to deal with problems, including: https://www.laleche.org.uk/ www.breastfeedingnetwork.org.uk www.abm.me.uk         https://www.nct.org.uk/baby-toddler/feeding https://breastfeeding.support/ https://globalhealthmedia.org/videos/breastfeeding/
  • The national charity Best Beginnings has created Baby Buddy, the free NHS approved app for pregnant women and new parents includes supportive daily information about breastfeeding, maternal mental health and more. Also, within the app you can watch over 30 films about breastfeeding including practical films on positioning and attachment. For anyone wanting to see the breastfeeding films via a website, you can click here: https://web.bestbeginnings.org.uk/web/videos/breastfeeding
  • For joint expert information from midwives and doctors on breastfeeding and caring for a baby during a COVID-19 infection or suspected infection, please visit this site and scroll down to find the later questions: https://www.rcog.org.uk/en/guidelines-research-services/guidelines/coronavirus-pregnancy/covid-19-virus-infection-and-pregnancy/
  • UNICEF Baby Friendly also has some useful resources here: https://www.unicef.org.uk/babyfriendly/COVID-19/

This information was prepared jointly by the breastfeeding support organisations.

If you are finding it hard to find your baby's usual brand of infant formula

For all babies a first infant formula should be used throughout the first year. If you are unable to get your usual brand of first infant formula, use another brand of first milk as all preparations have a similar nutritional composition to comply with legislation. There may be liquid ready to feed milk if no infant formula is available. Do not use a follow-on milk in the first 6 months. For babies 6 months or older and you cannot find your usual type of formula then use first infant formula. Your baby can stay on this formula throughout the first year. If you usually use another milk such as anti-reflux milk, or comfort milk and can't find these, then use first infant formula. Always make up infant formula as stated on the tin – do not add more water to make it last longer as diluting the milk could endanger your baby's health. If the main supermarkets have no infant formula, try local stores, pharmacies and corner shops. Many pharmacies will order products for their customers if asked. They are very busy just now. Links checked 22 March 2020 Adapted from: https://www.unicef.org.uk/babyfriendly/wp-content/uploads/sites/2/2020/03/Unicef-UK-Baby-Friendly-Initiative-statement-on-infant-feeding-during-the-Covid-19-outbreak-2.pdf More information on bottle feeding here: https://www.unicef.org.uk/babyfriendly/wp-content/uploads/sites/2/2008/02/start4life_guide_to_bottle_-feeding.pdf And: https://www.firststepsnutrition.org/infant-milks-overview

Protecting your mental health during anxious times

Feeling anxious is a very normal emotion. We are all anxious just now. You may be isolated from your family, or finding the usual support is not available. That's without the extra worry of coronavirus. These feelings are normal yet may feel overwhelming at times. Coronavirus, or COVID-19 feels threatening, both to ourselves and the people we care about.  Recognising this threat can help you work out how best to keep yourself safe.  Think about what is helping you and what is making you feel worse and then try to protect yourself from the negative things – including restricting time on social media. It is only necessary to seek help if you find your feelings spiralling out of control.   Tell your loved ones how you feel, this may be an opportunity to express your frustration and worries, which may be all that you need for just now. You can call the National Breastfeeding Helpline to talk about your concerns related to breastfeeding, if you can feel more confident about how you feed your baby it can take a lot of weight off your mind. Sources of help:

  • One You https://www.nhs.uk/oneyou/every-mind-matters/
  • Lots of good information here plus links to online CBT modules here: https://www.breastfeedingnetwork.org.uk/anxiety/
  • Mental Health Foundation have published a very good guide here https://mentalhealth.org.uk/coronavirus/staying-at-home
  • BfN's Big Tea Break – Moment of Calm https://www.youtube.com/watch?v=9T3KRiO2kaE – everyday should include at least 5 minutes of calm!
  • Anxiety UK have resources specific to coronavirus https://www.anxietyuk.org.uk/coronanxiety-support-resources/
  • Headspace has a section on stress and anxiety which may help you ground yourself by listening to your breathing, e.g. https://www.headspace.com/meditation/anxiety
  • https://www.mind.org.uk/information-support/coronavirus-and-your-wellbeing/#collapse834e3

Useful information for supporting children

Mindheart has published a short book to support and reassure children under the age of 7 about coronavirus. Covibook is available to download in 21 languages including English.  Read the news story: #COVIBOOK Supporting and reassuring children around the world
Read the book: Covibook (PDF)

https://www.unicef.org.au/blog/news-and-insights/march-2020/how-to-talk-to-your-children-about-coronavirus?dm_i=4W2U,BAIH,1FV16H,18L55,1

https://www.childline.org.uk/info-advice/your-feelings/anxiety-stress-panic/worries-about-the-world/coronavirus/

Mental Health and Wellbeing

The Anna Freud National Centre for Children and Families has published advice and guidance for Parents and Carers and Schools

https://www.annafreud.org/what-we-do/anna-freud-learning-network/coronavirus/

Coronavirus, mental health, wellbeing

There is much that each one of us can do to support the wellbeing of those in our lives. We don't know whether the coronavirus situation will impact on children and young people's mental health, but we think that it may.

www.annafreud.org

The Association for Child Mental Health has released a podcast discussing the coronavirus and children and young people's mental health.

Read the news story and listen to the podcast: https://player.fm/series/association-for-child-and-adolescent-mental-health-acamh/dr-jon-goldin-on-the-coronavirus-and-child-mental-health

Information about online safety

https://www.gov.uk/government/publications/child-safety-online-a-practical-guide-for-parents-and-carers/child-safety-online-a-practical-guide-for-parents-and-carers-whose-children-are-using-social-media

https://www.nspcc.org.uk/keeping-children-safe/online-safety/

You can find a summary and original NSPCC sources of information we have described above here

https://parentinfantfoundation.org.uk/first-advice-on-safeguarding/

https://www.nspcc.org.uk/keeping-children-safe/coronavirus-advice-suppport-children-families-parents/

Here are some of the latest guidelines:-
Other Information and further support

Every day more information is published on official government sites.  For accurate and up to date information please visit the Government Public Health website.  The Department of Health and Social Care will be publishing updated data on the following page every day until further notice NHS website Coronavirus (2019-nCoV). NHS Scotland – coronavirus NHS UK – coronavirus

Useful information for staying at home